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Caudal ropivacaine and ketamine for postoperative analgesia in children
1Department of Anaesthesiology, Intensive Care & Operating Services, Alice Ho Miu Ling Nethersole Hospital, 11 Chuen On Road, Tai Po, New Territories, Hong Kong.
Insights
Adding ketamine to ropivacaine significantly extended postoperative pain relief in boys undergoing circumcision. This combination therapy reduced the need for additional analgesia compared to ropivacaine alone.
Area of Science:
- Anesthesiology
- Pediatric Surgery
- Pain Management
Background:
- Postoperative pain management in pediatric surgical procedures like circumcision is crucial for patient recovery.
- Regional anesthesia techniques, such as caudal blocks, are commonly employed for analgesia in children.
Purpose of the Study:
- To evaluate the efficacy of caudal ketamine combined with ropivacaine for postoperative analgesia in boys undergoing outpatient circumcision.
- To compare the duration of analgesia and the requirement for additional pain medication between caudal ropivacaine alone and caudal ketamine/ropivacaine.
Main Methods:
- A prospective, randomized, double-blind clinical study involving 32 pediatric patients (18 months to 12 years) undergoing circumcision.
- Patients received either caudal ropivacaine 0.2% or caudal ropivacaine 0.2% plus ketamine 0.25 mg/kg.
- Postoperative pain was assessed using a visual analogue scale, with additional analgesia administered for scores >3.
Main Results:
- The ketamine/ropivacaine group experienced a significantly longer median duration of analgesia (12 hours) compared to the ropivacaine group (3 hours).
- Patients receiving ketamine/ropivacaine required significantly fewer additional doses of postoperative analgesia.
- No significant differences were observed in the incidence of nausea, vomiting, sedation, or other adverse events between the groups.
Conclusions:
- Caudal ketamine combined with ropivacaine provides prolonged and effective postoperative analgesia in pediatric patients undergoing circumcision.
- This combination therapy is a safe and beneficial option for reducing pain and the need for rescue analgesia in pediatric outpatient surgery.
- Further research may explore optimal ketamine dosages and its role in other pediatric surgical pain management protocols.
Abstract:
In a prospective, randomised, double-blind clinical study, we studied 32 ASA grade I and II boys aged 18 months to 12 years, scheduled for circumcision under general anaesthesia on an outpatient basis. They were randomly allocated to one of two groups: those in the ropivacaine group received caudal ropivacaine 0.2% 1 ml. kg-1 for postoperative analgesia and those in the ketamine/ropivacaine group received caudal ropivacaine 0.2% 1 ml. kg-1 plus caudal ketamine 0.25 mg.kg-1. Postoperative pain was assessed using a modified 10-cm visual analogue scale and analgesia was administered if the pain score exceeded a value of 3. The median duration of analgesia was significantly longer in the ketamine/ropivacaine group (12 h) than in the ropivacaine group (3 h, p < 0.0001), and subjects in the ropivacaine group required significantly more doses of postoperative analgesia than those in the ketamine/ropivacaine group (p < 0.0001). There were no differences between the groups in the incidence of postoperative nausea, vomiting, sedation, emergence delirium, nightmares, hallucinations, motor block and urinary retention.